Aug 2026· International Journal of Epilepsy· 0 citations· 26 references
TL;DR
The STEPSS >2 shows a moderate predictive performance of functional outcomes in children with SE at discharge and at 3-month follow-up, with clinically useful sensitivity and specificity.
Abstract
Abstract Objectives To evaluate the predictive performance of the Status Epilepticus in Pediatric Patients Severity Score (STEPSS) in predicting short-term functional outcomes in children presenting with status epilepticus (SE). Methods This ambispective study was conducted in a tertiary pediatric intensive care unit over 18 months. Seventy-six children, aged 1 month to 18 years, presenting with SE, were enrolled. The STEPSS was calculated at admission. This scoring system was adapted from prior pediatric studies with appropriate permissions. It encompasses factors such as consciousness, seizure type, age, and a history of previous seizures. Outcomes were assessed using the Pediatric Overall Performance Category (POPC) scale at discharge and 3-month follow-up. The predictive ability of STEPSS was evaluated using sensitivity, specificity, and receiver operating characteristic analysis. Results Of the 76 patients, 36 (47%) had an acute, symptomatic etiology. The median STEPSS was 2 (interquartile range: 1–3), with 36.8% of participants having a score greater than 2. Poor neurological outcomes (POPC scores >2) were noted in 31 (40.8%) children at discharge and 25 (33.7%) at follow-up. STEPSS >2 predicted unfavorable outcomes both at discharge and at 3-month follow-up. STEPSS >2 predicted poor outcomes at discharge with an area under the curve of 0.760 (95% confidence interval: 0.65–0.82, p < 0.001), yielding 75% accuracy, 64% sensitivity, 82% specificity, positive predictive value of 71%, and a negative predictive value of 77%. Conclusion The STEPSS >2 shows a moderate predictive performance of functional outcomes in children with SE at discharge and at 3-month follow-up, with clinically useful sensitivity and specificity. This tool can provide insight for management and may serve as a practical bedside tool.
BACKGROUND
Status epilepticus (SE) is a life-threatening condition in children, which is associated with significant morbidity and mortality. Early identification of high-risk patients with SE is of utmost importance to improve their outcome. The Status Epilepticus in Pediatric Patients Severity Score (STEPSS) is a simple clinical tool designed to predict the outcome of children with SE.
OBJECTIVE
The present study aimed to evaluate the clinical utility of the STEPSS score in predicting the outcome in children with SE.
MATERIALS AND METHODS
This was a cross-sectional study conducted in a pediatric intensive care unit of a tertiary care hospital for a period of 22 months. The study included 50 children aged 1 month to 16 years who presented with seizures for ≥5 min. STEPSS was calculated on admission using clinical parameters. The outcome was assessed by clinical status. Statistical analysis was done using SPSS version 26.
RESULTS
Of the 50 children with SE, 30 (60%) had STEPSS ≥3. Children with a lower STEPSS score (≤2) survived, whereas mortality was observed in 26.7% of those with STEPSS ≥3 (P = 0.0117). Unfavorable neurological outcomes were significantly higher in the ≥3 group. The STEPSS score demonstrated a sensitivity of 100% and specificity of 47.62% for predicting mortality with a diagnostic accuracy of 56%.
CONCLUSION
The STEPSS is a useful clinical tool for early prediction of outcome in children with SE. Despite high sensitivity and low specificity, the test showed a high Negative predictive value, making it useful in identifying children with a favorable outcome.
Dama Mahesh, Anilkumar Sajjan, V. J. Prakash et al.· Annals of African medicine· 0 citations
The ACARD score is a user-friendly tool developed to predict 30-day mortality after nonhypoxic SE and has the potential to identify participants at high risk of short-term mortality and outperform the performance of other available scoring systems.
Simona Lattanzi, E. Trinka, P. Bosque-Varela et al.· Neurology· 0 citations
Refractory status epilepticus (RSE) is a life-threatening neurological emergency in children. However, real-world evidence on pediatric RSE remains limited. This study characterized treatment patterns, in-hospital outcomes, and predictors of clinical outcomes within a resource-constrained regional referral network. We performed a single-center retrospective cohort study of pediatric patients admitted with RSE between March 2018 and March 2026. Demographic, clinical, treatment, and outcome data were systematically collected. A total of 215 pediatric RSE episodes were included (median age, 8.0 years; interquartile range [IQR], 5.8-11.8 years); 45.1% were female, and 39.5% had a history of epilepsy. All patients received benzodiazepines as first-line therapy, but only 67 episodes received guideline-recommended dosing. Diazepam, levetiracetam, and midazolam infusion were the most commonly used first-, second-, and third-line therapies, respectively. Favorable discharge outcomes were observed in 50.7% of patients and were independently associated with prior epilepsy (odds ratio [OR], 2.379; 95% confidence interval [CI], 1.07-5.27), adequate first-line benzodiazepine dosing (OR, 2.104; 95% CI, 1.02-4.33), and shorter duration of status epilepticus (OR, 1.991; 95% CI, 1.53-2.58). In-hospital mortality was 15.3% and was associated with acute etiologies (OR, 3.265; 95% CI, 1.27-8.40); prior epilepsy was inversely associated with mortality (OR, 0.328; 95% CI: 0.15-0.73). In-hospital mortality in pediatric RSE is associated with acute etiologies, whereas prior epilepsy is associated with lower mortality. Favorable functional outcomes are associated with prompt guideline-concordant first-line treatment and shorter seizure duration. These findings suggest that key prognostic determinants of pediatric RSE are consistent across different resource settings.
BACKGROUND & OBJECTIVES
Status epilepticus (SE) poses high risks of death and disability, yet most prognostic tools focus solely on mortality. The END-IT score is the only scale specifically developed to predict 3-month functional outcomes of SE. Hence, this study evaluated the performance of END-IT in adults with SE and explored additional predictors of 3-month functional outcomes.
METHODS
This prospective cohort study was conducted at a tertiary hospital in Egypt (August 2024-August 2025). Data collected included demographics, the Charlson Comorbidity Index (CCI), initial level of consciousness (as measured by the Glasgow Coma Scale [GCS] and FOUR score), seizure semiology, SE refractoriness, Status Epilepticus Severity Score (STESS), and all END-IT components. An unfavourable outcome was defined as a Modified Rankin Scale (mRS) score of 3-6 at the 3-month follow-up.
RESULTS
A total of 114 patients were enrolled (median age 33 years [IQR 17.75-54.25]). Most episodes were convulsive SE, while non-convulsive SE accounted for 4.4%. At 3 months, 55.3% had unfavourable outcomes, including 36.8% deaths. The sensitivity and specificity for unfavourable outcome prediction after 3 months for END-IT (≥3) = 0.524 and 0.843, respectively (Area under the curve = 0.747). The regression model revealed that higher CCI scores (OR = 2.06, 95% CI: 1.31-3.23, P = 0.002) and higher END-IT scores (OR = 1.67, 95% CI: 1.12-2.49, P = 0.013) were independently associated with unfavourable outcomes.
CONCLUSION
In this SE cohort, END-IT showed moderate prognostic performance for predicting 3-month functional outcomes. Incorporating comorbidity burden may enhance future prognostic models.
R. Magdy, N. Kishk, Ehab Shaker et al.· Epilepsy & Behavior· 0 citations
Background: Improved pediatric intensive care survival leaves many with long-term neurological impairments, highlighting the need for simple, reliable tools to monitor post-discharge functional outcomes. Objective of the study was to evaluate the utility of the pediatric cerebral performance category (PCPC) score in assessing neurological outcomes and predicting long-term prognosis among children admitted to the pediatric intensive care unit (PICU).
Methods: This prospective cohort study was conducted in the PICU of a tertiary care hospital and included 150 children aged 40 days to 14 years. Baseline demographic, clinical characteristics and pediatric risk of mortality (PRISM III-24) scores were recorded. Neurological outcome was assessed using the PCPC score at admission, discharge and follow-up over a period of one year. Risk factors were analyzed using multivariate logistic regression.
Results: Respiratory infection was the commonest indication for PICU admission. Neurological status deteriorated during critical illness with the proportion of children having normal neurological function decreasing from 72.0% before illness to 28.0% at discharge. Higher PRISM III-24 scores were associated with increased mortality and poorer neurological outcomes. Baseline neurological impairment, prolonged mechanical ventilation, seizures, cardiopulmonary resuscitation, central nervous system infections, and a discharge PCPC score ≥4 were significant predictors of adverse outcomes. Twelve children died during the study period. A discharge PCPC score ≥4 predicted poor neurological outcome at 12 months with a sensitivity of 75.0%, specificity of 84.9%, and AUC of 0.86 (95% CI 0.79-0.93).
Conclusions: The PCPC score is a simplest and reliable clinical tool for evaluating neurological progression and predicting long-term prognosis in critically ill children.
M. Shahid, S. N. Singh, Rachana Bhatnagar et al.· International Journal of Con...· 0 citations
Real-world insights into RSE in a resource-limited setting are offered, highlighting preventable causes, management complexity, and high care demands, and favorable outcomes are often achievable.
Jocelyn Cruz-Pérez, J. Zepeda-Pérez, E. Z. Camacho-Castillo et al.· Neurocritical Care· 0 citations
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